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My own medical education began in earnest when I was able to relate the science of medicine to people – the individual cases that make up clinical practice. Their narratives brought medicine alive. As such experience builds, so too does the clinician’s awareness of the range of different presentations of even the commonest condition. The third edition of Clinical Problems in Medicine and Surgery exploits this ‘case-based learning’ approach to great effect. A carefully selected array of important clinical problems covering a broad range of medical and surgical conditions provide the substrate for questions that probe the reader’s understanding of the underlying pathology and, importantly, link the elements of the clinical reasoning process. The sequential approach adopted resonates with the intrinsic uncertainty of real clinical practice and the requirement to reassess as conditions change. Investigations, including imaging, are clearly presented. It is increasingly accepted that problem-based learning instills a deeper appreciation of principles. So too does a requirement to reiterate these same principles in a different context – here the Points for Revision sections will prove to be of great value to the student of medical practice. No compendium of clinical problems can ever be complete. But this is a compelling collection that can contribute much to the acquisition of clinical expertise. Importantly it is a stimulus to a rigorous reasoned approach to diagnosis and management, and the understanding of the scientific basis of medicine upon which sound medical practice depends. Professor Sir John Tooke

THE PROBLEMS 1 Difficulties with postoperative fluid balance in a 58-year-old man

1 Richard J. Krysztopik

2 Postoperative fever 10 Wendy A. Brown

3 Postoperative hypotension 14 Paul C. Leeder and Sujad Kiani

4 Confusion in the postoperative ward 26 Toby T. Winton-Brown

5 Swelling in the neck in a 58-year-old man 32 Jonathan W. Serpell

6 A 42-year-old woman with hypertension 41 Lucia Gagliardi

7 A young woman with abnormal vaginal bleeding 49 Roger J. Pepperell

8 A scrotal swelling in a 27-year-old man 54 Jimmy Lam

9 A 63-year-old woman with a screen-detected abnormality 59 James Kollias